Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature.

Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.

Mental toughness of mixed martial arts athletes at different levels of competition.

This study investigated whether mental toughness distinguishes mixed martial arts (MMA) athletes competing at different levels. It was theorized that higher mental toughness would separate those competing at the professional level compared to lower levels. Male MMA competitors (N = 136, M age = 27.1 yr., SD = 4.8) were categorized as amateur, semi-professional, or professional and assessed by questionnaire using the Psychological Performance Inventory-A and the Sports Mental Toughness Questionnaire. There were statistically significant differences between the three groups on mental toughness. The professional group had higher scores compared to semi-professional and amateur groups with regard to confidence, positive cognition, and determination. The findings supported previous work that athletes performing at higher levels have superior mental toughness.